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	Oralin Order Form - Print form and fill out form as applicable.
	Pay by Credit Card - Fill out Section 1, Section 2 (if shipping address is different from Section 1), and Section 3.
	Pay by Check or Money Order - Fill out Section 2 and Section 3. We accept U.S. funds however
	no exchange is given. Make payable to: Oralin Centre
	We do accept payments in cash however, for your own protection we suggest paying by credit card,
	check or Money Order.
	Order By Mail: Send form and payment to:			Oralin
				1-5 Church Street
				Orangeville, Ontario
				Canada L9W 1N1
	Section 1 - Enter the address to which your card statement is mailed. An incorrect address may result in your payment being rejected.
	Cardholder Name:
	Company (Optional):
	Cardholder Address:
	City:			Prov./State:
	Postal/ZIP Code:			Country:
	Phone Number:
	Email Address:
	Cardholder Name:
	Card Number:
	Expiry Date (mm/yy):
	Authorization Signature:
	Section 2 - Shipping Address
	Name:
	Address:
	Address:
	City:			Prov./State:
	Postal/ZIP Code:			Country:
	Phone Number:
	Email Address:
	Section 3 - Order Form (Prices in CDN Dollars)
	Item Description				Quantity	Price per	Total
					Ordered	Item	Price
	Sub-Total
	Add 5% GST to Sub-Total
	Total of Order: